I never thought I would miss eating in a hospital cafeteria. Before COVID-19, I would enjoy taking a meal break and chatting with colleagues. But that respite and others like it aren’t coming back for a while.
Sometimes this is a profoundly sad thought. In these uncertain times, I’m often nostalgic for the familiarity and routine of the old days.
However, uncertainty can also be a massive catalyst for change. I’m hopeful that the pandemic will achieve what rising costs, government regulations, and declining margins could not. At long last, we may be on the cusp of a sea change in acute care that makes our delivery system more cost-efficient, better for physician resilience, and keenly focused on patient-centric care.
No Going Back
COVID-19 is the most significant healthcare disrupter of our lifetime. For years, we’ve been talking about healthcare reform as a goal to be worked toward over years or decades. Now, our hospitals and health systems are being forced to change at a pace that has been likened to building an airplane in midflight.
To weather this transformation, we must accept that there is no “post-COVID world.” The virus is likely to be with us for years to come, if not forever. (Six years after the Spanish Flu pandemic ended, hospitals were still admitting elevated numbers of patients with mental health and neurological sequelae.) This radical reorganization of our reality is necessary — and it will touch every healthcare institution, starting with hospitals.
The pandemic has made it imperative to meet patients where they are. We no longer have the luxury of operating under provider-centric models that force patients to travel to offices and hospitals for minor injuries and illnesses. Instead, we now depend on technology to safely treat patients, conserve personal protection equipment, and slow the spread of the virus.
This shift is perhaps best exemplified by the rapid ascendency of telehealth, now almost ubiquitous after decades of sluggish growth. In some parts of the country, demand for telehealth visits has increased by several thousand percent. What’s more, both patients and providers are enjoying the flexibility, convenience, and (often) lower cost of telehealth encounters. As a result, physician and patient advocacy groups are working to permanently enshrine the emergency telehealth regulations into long-term expanded access and reimbursement.
What will the hospitals of the future look like in this decentralized, technology-driven world? Perhaps the most striking difference will be the shift from the physical to the virtual hospital. In this new model, only the most acute patients will receive in-person care. The rest will be managed in their homes, skilled nursing facilities, and wherever else they can be cared for virtually.
“To meet the ongoing challenges of coronavirus, we must engage our clinicians as champions and co-creators. ”
Denise Brown, MD
Chief Growth Officer
Solving Our Most Pressing Challenges
By connecting patients and providers in new ways, delivery models are also driving a grassroots movement toward expanded access and quality. This high-tech and high-touch re-engineering of our nation’s healthcare delivery system may finally provide solutions to some of the toughest problems in acute care, like:
- Physician shortages
Some new technologies have the potential to “force multiply” physicians. For example, today’s virtual care platforms can leverage artificial intelligence and natural language processing to automate patient communication and arrive at a preliminary diagnosis and treatment plan. This allows a single attending physician to virtually manage the care of several patients at once. These technologies could help health systems to better navigate provider shortages due to COVID surges as well as the looming national provider shortage
- Geographical health disparities
Virtual hospitals could also solve access issues for patients in rural and underserved areas. For example, patients receiving some types of medications for addiction treatment (MAT) previously traveled to outpatient treatment programs daily. The shift to new virtual treatment models could make MAT feasible for patients who are homebound, live far from clinics, or are unable to travel daily due to work or family commitments.
- Clinical quality and outcomes
Virtual hospitals of the future could also leverage technology to improve preventative care. For example, AI platforms can now predict negative events like heart attacks up to 5 years before they occur. These algorithms could be built into care delivery systems to trigger clinical intervention ahead of a serious health event.
- Capacity management
In addition to freeing inpatient beds ahead of potential COVID surges, virtual hospitals could also give patients an additional choice to seek out emergency care. Telehealth triage platforms like Vituity’s ensure that only those patients who genuinely need face-to-face care travel to the ED. (The convenience of this approach would also likely satisfy patients.)
Physicians: Our Greatest Innovation Assets
The shift from a physical to a virtual hospital represents a seismic shift in care delivery. After all, despite the clear advantages of virtual acute care, it has taken a global pandemic for the idea to gain traction. As with any significant change, healthcare leaders should prepare to endure resistance and gain buy-in for this new care delivery paradigm.
To foster this change, we must nurture a culture of physician resilience and empowerment. Clinicians represent our most direct connections to our patients. Often, they are the first to recognize both pain points and potential solutions. As such, they are our most valuable innovation assets. To meet the ongoing challenges of coronavirus, we must engage our clinicians as champions and co-creators.
As a physician-owned and physician-led organization, Vituity has benefited richly from provider-led innovation. A recent standout example is our virtual front door to the ED program, which allows patients to begin their ED visit by clicking a button on the hospital app or website. This immediately connects the patient to an ED provider who takes a history and determines next steps. In some cases, the clinician may treat the patient virtually, prescribe medications electronically, and even schedule appropriate follow-up appointments. More acute patients will be urged to travel to the ED to complete the visit in person, often with the same provider.
Another example is Hospital@Home, a new partnership between Vituity and Adventist Health. The program enrolls patients who meet safety and diagnostic criteria in a 150-bed virtual medical-surgical unit served by telehealth, remote monitoring, and mobile provider teams. This shift in the way we care for patients requires adjustment but may eventually prove to be the ultimate clinician satisfier. Many providers who sign up to provide virtual care expect the experience to be distancing. However, after a few weeks in this space, clinicians often report feeling more connected to patients and receiving far more “thank-you’s” than in their office and hospital jobs.
Hospitals aren’t about to disappear. However, they will shift their focus to the highest-acuity patients. This is where the emphasis will continue to move to health systems, which, by their nature, leverage multiple models of patient care. From live to virtual, a health system that meets patients where they are can more effectively care for everyone while controlling costs and stewarding the health of their workforces.
As shared owners in a physician-led organization, Vituity Partners are committed to leading this acute care evolution. We are excited to partner with like-minded organizations to begin creating a more affordable, accessible, and sustainable future for healthcare.